Abstract

To the Editor: Dr. Normal O. Rothermich, in the June issue of the ANNALS, criticized Question No. 92 which had appeared the previous December. This question concerned hemarthrosis after anticoagulant therapy in a man with acute myocardial infarction.

The basic purpose of this question was to point out the synergestic effect of phenylbutazone on Coumadin⌖-type anticoagulants. I agree that hemarthrosis after routine anticoagulation is quite rare, but enhancement of the anticoagulant effect with certain drugs (such as phenylbutazone) make this complication much more likely.

The value of synovianalysis is again emphasized by this question. The three most likely diagnoses in